drug therapy coronary heart disease

Question 1

chronic coronary artery disease (CAD) results from

Answer 1

damage to the intima (inner layer) of coronary arteries = build up of lipids and fiber in lumens

Question 2

CAD is also known as

Answer 2

the narrowing or blockage of the coronary arteries, usually caused by arteriosclerosis

Question 3

what is arteriosclerosis

Answer 3

hardening or clogging of the arteries; a build up cholesterol and fatty deposits (plaques) on the inner walls of the arteries

Question 4

plaque in the arteries to what

Answer 4

decrease the diameter of the artery, increasing macrophage to degrade the plaque, resulting in the plaque rupturing = endothelium injury, aggrevates platelet = thrombus = release of chemical mediators thromboxane, serotonin, platelet regrowth = vasoconstriction = further narrowing coronary arteries, less oxygen to tissue and worsen myocardial ischemia (reduced blood flow)

Question 5

symptom of coronary heart disease

Answer 5

chest pain, very very bad

Question 6

risks factors for developing CAD

Answer 6

smoking, abnormal cholesterol level(hyperlipidemia), high BP, obesity, DM, little exercise, age (men>45, women>55), ethnicity, hx of preeclampsia, genetics(male<55, female<65)

Question 7

CAD clinical manifestation

Answer 7

stable angina, variant angina

Question 8

what is stable angina

Answer 8

classic, typical, exertion angina

Question 9

what results from stable angina

Answer 9

when myocardial O2 demand is greater than the O2 supply to the heart muscle; from exercise, physical exertion elemental exposer to the cold emotion/stress

Question 10

substernal chest pain (CP) is what; part of stable angina

Answer 10

squeezing, may radiate to jaw, neck, shoulders, arm (brief: 5 mins- O2 restoration helps)

Question 11

signs of substerbal CP/ stable angina

Answer 11

SOB, diaphoresis, N/V, mistaken for arthritis pain/ GI disturbances, gender differences exist in symptom quality

Question 12

treatment for stable angina

Answer 12

thrombolytics(lyse the clot) & interventional therapies; calcium channel blockers, beta blockers, nitrates (relieve s/sx), increase exercise tolerance and life, delay CAD progression

Question 13

what Is variant angina

Answer 13

occurs at rest/ minimal exertion, occurs at same time of day, cyclic 3-6 months subsides

Question 14

acute coronary syndrome (ACS)

Answer 14

unstable angina; acute pain occurs at rest and lasts longer than 20 mins; can occur hours/ days prior to acute myocardial infarction

Question 15

2 types of myocardial infarcts (MI)

Answer 15

nstemi and stemi

Question 16

nstemi MI

Answer 16

non ST elevate myocardial infarction

Question 17

stemi MI

Answer 17

greater than 20 minute persistent ST elevation on ECG; very dangerous

Question 18

labs for myocardial infarctions

Answer 18

creatine kinase: cardiac isoenzyme(shows damage to the heart); cardiac troponin 1 & troponin T: biomarker of myocyte injury(cell damage)

Question 19

nonpharmacologic management of CAD

Answer 19

lifestyle changes & medications; obesity, stop smoking, patient education, interventional procedures (cardiac catheterization, coronary artery bypass graft, intracoronary stent)

Question 20

antianginal agents used to

Answer 20

improve O2 delivery or decrease consumption; used alone of in combination with other cardiac medications

Question 21

abtianginal agents will

Answer 21

dilate blood vessels, decrease cardiac workload

Question 22

types of antianginal agents

Answer 22

nitrates, beta adrenergic blockers, calcium channel blockers

Question 23

nitrates are

Answer 23

potent vasodilators

Question 24

examples of nitrates

Answer 24

nitroglycerin, isosorbide dinitrate

Question 25

therapeutic actions of nitrates

Answer 25

relax and dilate veins, arteries, and capillaries(systemic vascular dilatation): increase blood flow, lower systolic pressure; relief of and prevention of angina pain; decreases preload and after load

Question 26

adverse effects of nitrates

Answer 26

severe HA, dizziness, bradycardia, syncope, hypotension/ orthostatic

Question 27

what other symptom may you see with the use of nitrate

Answer 27

reflex tachycardia in response to hypotension (heart thinks it needs to speed up)

Question 28

how is nitrate given

Answer 28

may be SL(first pass effect with SL)(most common: 3 dose q 5 min/ while administering 3rd dose call 911 if at home), translingual spray, transdermal patch, topical ointment, PO, or IV

Question 29

the half of nitrate

Answer 29

rapidly absorbed/ half life = 1 to 4 minutes

Question 30

where is nitrate metabolized

Answer 30

in the liver, excreted in urine

Question 31

nursing considerations for nitrates

Answer 31

check vitals, BP prior and after administration (should see a drop)

Question 32

beta-adrenergic blockers examples

Answer 32

atenolol, metoprolol, bisoprolol (cardio selective)

Question 33

therapeutic actions of beta adrenergic blockers

Answer 33

decrease cardiac workload by slowing HR, decrease BP and reduce contractility(increase O2 to the heart), cornerstone daily med for patients with angina, decreases need for SL nitroglycerin for angina

Question 34

beta adrenergic blockers treats

Answer 34

angina, HTN, prophylaxis/ tx post MI

Question 35

caution of beta adrenergic blockers

Answer 35

in 2nd/3rd degree heart block, cariogenic shock, severe bradycardia, hypotension, heart failure

Question 36

black box warning on beta adrenergic blockers

Answer 36

do not stop abruptly, taper off; its well tolerates in patient with renal impairment/ may slow renal function decline

Question 37

example of calcium channel blockers

Answer 37

nifedipine

Question 38

therapeutic action of calcium channel blockers

Answer 38

inhibit the influx of calcium entering through slow channels, producing vasodilation of the peripheral blood vessels and coronary arteries (it does not affect the HR)

Question 39

pharmacokinetics of calcium channel blockers

Answer 39

first pass metabolism in the liver, fecal and urinary excretion

Question 40

adverse effects of calcium channel blockers

Answer 40

hypotension, flushing, HA, dizziness, lower limp edema, reflex tachycardia; dose related

Question 41

nursing considerations when using calcium channel blockers

Answer 41

check vitals, BP prior to and after administration (grapefruit juice will increase effect of medications/ do not use with adrenergic stimulants(cocaine), will increase digoxin levels

Question 42

adjunctive abtianginal drugs

Answer 42

ranolazine, dyslipiemic drugs, antihypertensive, morphine, anti platelets

Question 43

ranolazine is what

Answer 43

anti-ischemic metabolic modulator = first line tx for chronic angina

Question 44

dyslipidemic drugs do what

Answer 44

management of patients with major risk factors for atherosclerosis and vascular disorders (CAD, stroke, and peripheral arterial insufficiency)when lifestyle changes alone do not reduce blood lipids

Question 45

antihypertensive drugs do what

Answer 45

decrease peripheral vascular resistance can tx angina (ex. ACE inhibitors)

Question 46

morphine does what

Answer 46

helps pain/ anxiety, decreases preload; primary deliver in pain management in post MI in patients with unacceptable levels of pain

Question 47

antiplatelets examples/ do what

Answer 47

aspirin: at lower doses effectively suppress platelet aggregation w/o affecting important endothelial cell function; adenosine diphosphate (ADP) receptor antagonists: similar effects; glycoprotein (GP): inhibit platelet aggregation as well

Question 48

what is the purpose of giving thrombolytic agents following a stemi

Answer 48

is to dissolve thrombi and reestablish blood flow as quickly as possible, prevent or limit tissue damage, and maximize functional improvement. the antiplatelets are daily medication for prevention

Question 49

goals of therapy for antianginal drugs

Answer 49

relieve acute anginal pain, reduce number and severity of acute annginal attacks, improve exercise tolerance and life quality, delay progression of CAD, prevent MI and sudden cardiac death

Question 50

tolerance to long acting nitrate- antianginal drugs

Answer 50

develops with high dose, uninterrupted therapy; decrease adverse effects and efficacy

Question 51

preventing tolerance strategies: administer lowest effective dose and?

Answer 51

avoid ling acting forms of nitrates, only use long acting forms during waking hours